Comparison of double chevron-cut and biplanar distal femoral osteotomy techniques: A biomechanical study

OBJECTIVE

This study aimed to compare the stability and mechanical properties of the double chevron-cut (DCC) and biplanar (BP) distal femoral osteotomy (DFO) techniques, along with analyzing their respective contact surface areas.

METHODS

Biomechanical testing was performed using sawbone and 3D modeling techniques to assess axial and torsional stability, torsional stiffness, and maximum torque of both osteotomy configurations. Additionally, 3D models of the sawbone femur were created to calculate and compare the contact surface area of the DCC, BP, and conventional single-plane DFO techniques.

RESULTS

Axial stiffness and maximum strength did not significantly differ between the two osteotomy techniques. However, in terms of torsional properties, the DCC technique exhibited superior torsional stiffness compared to the BP group (27 ± 7.7 Nm/° vs. 4.5 ± 1.5 Nm/°, p = 0.008). Although the difference in maximum torque did not reach statistical significance (63 ± 10.6 vs. 56 ± 12.1, p = 0.87), it is noteworthy that the DCC group sawbone model exhibited fracture in the shaft region instead of at the osteotomy site. Therefore, the actual maximum torque of the DCC construct may not be accurately reflected by the numerical values obtained in this study. The contact surface area analysis revealed that the BP configuration had the largest contact surface area, 111% larger than that of the single-plane configuration. but 60% of it relied on the less reliable axial cut. Conversely, the DCC osteotomy offered a 31% larger contact surface area than the single-plane configuration, with both surfaces being weight-bearing.

CONCLUSION

The DCC osteotomy exhibited superior mechanical stability, showing improved rotational stiffness and maximum torque when compared to the BP osteotomy. Although the BP osteotomy resulted in a larger contact surface area than the DCC osteotomy, both were larger than the conventional single-plane configuration. In clinical practice, both the DCC and BP techniques should be evaluated based on patient-specific characteristics and surgical goals.

Comparing the Outcomes of Suture Anchor Repair and Rein-Type Capsular Suture for Triangular Fibrocartilage Complex Foveal Tears With a Minimum 2-Year Follow-Up

PURPOSE

Recent biomechanical studies have highlighted the importance of foveal reinsertion when repairing triangular fibrocartilage complex (TFCC) injury with foveal tears. However, clinical studies comparing different repair techniques are scarce. We compared the clinical outcomes of suture anchor repair and rein-type capsular suture in patients with TFCC palmer 1B foveal tears with a minimum of 2-year follow-up.

METHODS

This was a single-surgeon, single-center, retrospective, comparative study. We included patients who underwent TFCC repair surgery due to a foveal tear from December 2013 to October 2018 with a minimum follow-up of 24 months. Postoperative Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, Modified Mayo Wrist Score, visual analogue scale for pain, wrist range of motion, and grip strength were compared. We also measured the maximal ulnar head displacement with dynamic ultrasound to quantify distal radioulnar joint stability.

RESULTS

In total, 103 patients were in the suture anchor group (group A) and 84 patients in the rein-type capsular suture group (group B). The mean follow-up time exceeded three years for both groups. There was a minimal difference regarding QuickDASH score, visual analogue scale for pain, and grip strength ratio between the two groups. The rein-type group had significantly better Modified Mayo Wrist Score. The suture anchor group showed better distal radioulnar joint stability with dynamic ultrasound, but was more limited in ulnar deviation. However, these differences are most likely clinically insignificant.

CONCLUSIONS

Both suture anchor repair and rein-type capsular suture yielded satisfactory results for TFCC 1B foveal tear in a minimum of 2-year follow-up. The functional scores were similar, and no major complications or recurrent instability were noted in either group.

TYPE OF STUDY/LEVEL OF EVIDENCE

Retrospective Therapeutic Comparative Investigation IV.

Reducing surgical site infections after spine surgery: the optimal amount of normal saline for intra-wound irrigation

BACKGROUND CONTEXT

Surgical site infection (SSI) following lumbar surgery can increase healthcare costs and lead to poor clinical outcome. Irrigation of wounds with saline solution is widely accepted globally and safe for nearly all kinds of surgery. However, the efficacy of different volumes of wound irrigation has not been addressed in elective spine surgery. The role and the optimal amount of intraoperative wound saline irrigation in preventing SSI in clean spinal surgery remain unclear.

PURPOSE

We aimed to investigate if insufficient intraoperative irrigation may be a risk factor for postoperative SSI. Additionally, we investigated the optimal amount of normal saline (NS) for irrigation to prevent postoperative SSI.

STUDY DESIGN

This is a retrospective study of patients with degenerative spinal stenosis who were treated surgically. Patients were grouped according to the amount of intra-wound irrigation during surgery.

PATIENT SAMPLE

We included 444 patients with degenerative lumbar spinal conditions who had undergone one to five level open spinal fusion surgeries from January 2015 through April 2020.

OUTCOME MEASURES

The definition of superficial or deep SSI in this study was based on the Centers for Disease Control and Prevention criteria for SSI. The fusion status accessed was based on the Bridwell grading system at the final follow-up. Self-reported and clinical outcome measures include visual analog scale and Oswestry Disability Index.

METHODS

A total of 193 patients underwent irrigation with a bulb syringe with manual method (B group) with 2,000 mL NS; 251 patients underwent interpulse battery-powered device irrigation (P group) with >6,000 mL NS. Based on our protocolized departmental guidelines, all patients received the same preoperative preparation and standard surgical steps and postoperative care plan. Patients' demographic and surgical parameters were recorded. The main outcome measures included superficial wound infection, deep infection and overall infection.

RESULTS

The incidence of overall SSI was 4.66% in the B group and 1.59% in the P group. The univariate analysis revealed a significant correlation with DM and irrigation amount per hour during surgery but not age, BMI, smoking, operative duration, fusion level, or blood loss. We determined the optimal irrigation amount during surgery as 1,400 mL per hour based on the receiver operating characteristic (ROC) curve (sensitivity, 92.3%; specificity, 44.1%). This was statistically significant (p=.033) with an odds ratio of 9.284 (95% confidence interval 1.2-72.0). In the analysis of surgical factors, the infection group had a significantly lower irrigation amount during surgery. To summarize, patients with diabetes and those receiving less than 1,400 mL of NS/hour had a higher likelihood of developing SSI.

CONCLUSIONS

We observed that diabetes and lower volume of intraoperative irrigation were both risk factors for postoperative SSI following degenerative lumbar spine surgery. To reduce SSI in lumbar spine surgery, intra-wound irrigation with more than 1,400 mL/h of NS was recommended.

Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study

BACKGROUND

This prospective randomized controlled study compares the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures.

METHODS

The cohort of 100 patients who underwent percutaneous kyphoplasty was randomly divided into group A (guide pin and balloon introduced directly into fracture site) and group B (guide pin and balloon inserted away fracture site). The surgery duration, clinical and radiological outcomes postoperatively and at follow-up, and complications of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. The clinical outcomes were assessed using the Oswestry Disability Index and visual analog scale.

RESULTS

The two groups had similar patient demographics, surgery times, and volume of cement injected. The method using elevation of the collapsed endplate indirectly had no significant influence on radiological outcomes but significantly decreased the occurrence of intradiscal cement leakage and improved 1- and 12-month postoperative functional outcomes.

CONCLUSION

Elevating and reinforcing the collapsed endplate rather than just filling the defect during percutaneous kyphoplasty is safe and effective. This technique decreased pain and improved function with lower rates of further collapse of the osteoporotic vertebrae compared to defect-filling alone.

Favoring the Selective H2O2 Generation of a Self-Antibiofouling Dissolved Oxygen Sensor for Real-Time Online Monitoring via Surface-Engineered N-Doped Reduced Graphene Oxide

Dissolved oxygen (DO) is a key parameter in assessing water quality, particularly in aquatic ecosystems. The oxygen reduction reaction (ORR) has notable prevalence in energy conversion and biological processes, including biosensing. Nevertheless, the long-term usage of the submersible DO sensors leads to undesirable biofilm formation on the electrode surface, deteriorating their sensitivity and stability. Recently, the reactive oxygen species (ROS), such as the two-electron pathway ORR byproduct, H2O2, had been known for its biofilm-degradation activity. Herein, for the first time, we reported N-doped reduced graphene oxide (N-rGO) for H2O2 selectivity as the self-antibiofouling DO sensor. Introducing foreign atom doping could reorient the electron network of graphene by the electronegativity gap, which facilitated highly selective and efficient two electron pathway of ORR. Mitigating the N content of N-rGO had enhanced the H2O2 selectivity (57.5%) and electron transfer number (n = 2.84) in neutral medium. Moreover, the N-rGO could be integrated to a wireless DO monitoring device that might realize an applicable device in the aquatic fish farming.

The Impact of Cage and End plate-Related Factors on Cage Subsidence in Oblique Lateral Interbody Fusion

OBJECTIVES

To identify cage and end plate factors of cage subsidence (CS) in patients who underwent oblique lateral interbody fusion (OLIF) and their association with patient-reported outcomes.

METHODS

Sixty-one patients (43 women and 18 men), with a total of 69 segments (138 end plates) which underwent OLIF at a single academic institution between November 2018 and November 2020, were included. All the end plates were separated into CS and nonsubsidence groups. Cage-related parameters (cage height, cage width, cage insertion level, and cage position) and end plate-related parameters (position of end plate, Hounsfield unit value of the vertebra, end plate concave angle [ECA], end plate injury, and angular mismatch measured with cage/end plate angle [C/EA]) were compared and analyzed using logistic regression to predict CS. Receiver operating characteristic curve analysis was used to determine the cutoff points of the parameters.

RESULTS

Postoperative CS was identified in 50 of the 138 end plates (36.2%). The CS group had significantly lower mean Hounsfield unit values of the vertebra, higher rate of end plate injury, lower ECA, and higher C/EA than the nonsubsidence group. ECA and C/EA were identified as independent risk factors for developing CS. The optimal cutoff points for ECA and C/EA were 176.9° and 5.4°, respectively.

CONCLUSIONS

An ECA greater than 176.9° and a cage/end plate angular mismatch greater than 5.4° were found to be independent risk factors of postoperative CS after the OLIF procedure. These findings aid in preoperative decision-making and intraoperative technical guidance.

Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

BACKGROUND

Postvertebroplasty infection (PVI) is a catastrophic complication after vertebroplasty (VP). Although the urinary tract has been considered as a source of infectious pathogens, whether asymptomatic bacteriuria (ASB) is a risk factors for PVI remains unknown.

METHODS

This retrospective study included 716 patients (207 males; 509 females) treated with VP for osteoporotic vertebral fractures in a single medical center between May 2015 and December 2019. Clinical symptoms, urinalysis results, and culture data were collected preoperatively to identify patients with ASB. The primary outcome was PVI at the index level during follow-up. Demographic data and laboratory test results were compared between the PVI and non-PVI groups.

RESULTS

The mean age of the cohort was 78.6 ± 9.6 (range, 63-106). The prevalence of ASB was 14.1%, with female predominance (63.4%). The overall PVI rate was 1.26% (9/716). The PVI group had more patients with ASB (4/9, 44.4%) than did the non-PVI group (97/707, 13.7%) (p = 0.027). The rate of ASB treatment was similar between the PVI and non-PVI groups (25% vs. 23.7%, respectively). No case of PVI was caused by the urine culture pathogen. Multivariate analysis identified the following risk factors for PVI: ASB (odds ratio [OR], 5.61; 95% CI, 1.14-27.66; p = 0.034), smoking (OR, 16.26; 95% CI, 2.58-102.65; p = 0.003), and malignancy (OR 7.27; 95% CI, 1.31-40.31; p = 0.023).

CONCLUSION

ASB was not uncommon among patients admitted for VP and should be considered a marker of relatively poor host immunity. Preoperative ASB, a history of malignancy, and smoking were identified as significant risk factors for PVI.

Effectiveness of exercise in improving quality of life in patients with traumatic brain injury: A systematic review and meta-analysis

BACKGROUND

Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide. People with TBI exhibit poor quality of life (QOL). Exercise is considered a possible intervention for improving cognitive function and mood, helping improve QOL in patients with TBI. According to our review of the relevant literature, meta-analyses have yet to explore the effect of exercise on QOL in patients with TBI.

OBJECTIVES

To determine by meta-analysis of relevant studies whether physical exercise could promote QOL in patients with TBI.

METHODS

A systematic review and meta-analysis of intervention studies involving physical exercise for improving QOL outcomes in TBI populations were conducted according to the PRISMA guideline. Our inclusion criteria were as follows: being randomized or nonrandomized controlled trials with quantitative designs that included patients diagnosed with TBI.

RESULTS

Thus, six studies met the inclusion criteria. The interventions in four of the six studies had statistically significant effects on QOL improvement. Our meta-analysis revealed a moderate effect size of physical exercise on QOL promotion in patients with TBI.

CONCLUSION

For TBI, exercise seems to improve QOL. More research with long-term follow-up should be conducted to assess the effect of exercise on patients with TBI.

Refractive status, biometric components, and functional outcomes of patients with threshold retinopathy of prematurity: systemic review and a 17-year longitudinal study

OBJECTIVE

To assess the long-term refractive status, visual outcome, astigmatism, and the change in biometric optic components in older adolescents up to age 17 years with threshold retinopathy of prematurity (ROP) treated with diode laser.

METHODS

A retrospective, longitudinal study in which cycloplegic refraction, keratometry, and the biometric measurement of optic components were performed on 28 consecutive preterm eyes with laser-treated threshold ROP at age 17 years. The study results were statistically analysed and compared with age-matched full-term control.

RESULTS

All patients with ROP had myopia (average spherical equivalent of - 6.35 D, ranges from - 1.25 to - 12.38 D), and 12 eyes (43%) were highly myopic (spherical equivalent <  - 6.0 D). Threshold ROP eyes exhibited a significantly poorer visual acuity (P < 0.001), greater cylinder refractive error (P < 0.001), higher corneal astigmatism (P < 0.001), and flatter horizontal corneal curvature (P = 0.01) compared with age-matched controls. Biometric optic components analysis revealed a significant shallower anterior chamber depth (P < 0.001), thicker lens (P < 0.001), and shorter axial length (P = 0.021) in laser-treated ROP eyes compared with age-matched controls.

CONCLUSIONS

In this 17-year longitudinal study, a higher prevalence of myopia and astigmatism was observed in laser-treated threshold ROP eyes compared with age-matched control eyes. Myopia and astigmatism in laser-treated ROP eyes typically progress through adolescence after school age. Therefore, we recommend that preterm patients with laser-treated threshold ROP should attend regular follow-up not only for refractive status but also for structural change of anterior segment until their adolescence.

Corrective osteotomy for distal condylar malunion of the proximal phalanx in adolescents: comparison of K-wire and locking plate fixation

This retrospective study reviewed 28 patients, aged 10 to 17 years, who underwent corrective osteotomy for malunion of the proximal phalangeal distal condyles at a mean of 9 weeks (range 2-52) from injury. There were 19 patients treated with K-wire and nine patients with locking plates. The two groups were comparable for trauma mechanism, fracture type, time delay from injury and the type of initial treatment. The K-wire group had a shorter duration of operation and shorter time to union than the plating group. For both groups, postoperative radiographs showed significant correction, which remained unchanged until the final follow-up (minimum 12 months), although greater residual coronal angulation was found in the K-wire group. The outcomes in 17 of the 28 patients were graded as excellent or good according to the Al-Qattan classification, with no difference between the groups. The complication rate was also similar between the groups, while the locking plate group had a higher rate of secondary surgery.Level of evidence: III.

AMPK promotes Arf6 activation in a kinase-independent manner upon energy deprivation

AMP-activated protein kinase (AMPK) is a crucial cellular nutrient and energy sensor that maintains energy homeostasis. AMPK also governs cancer cell invasion and migration by regulating gene expression and activating multiple cellular signaling pathways. ADP-ribosylation factor 6 (Arf6) can be activated via nucleotide exchange by guanine-nucleotide-exchange factors (GEFs), and its activation also regulates tumor invasion and migration. By studying GEF-mediated Arf6 activation, we have elucidated that AMPK functions as a noncanonical GEF for Arf6 in a kinase-independent manner. Moreover, by examining the physiological role of the AMPK–Arf6 axis, we have determined that AMPK activates Arf6 upon glucose starvation and 5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside (AICAR) treatment. We have further identified the binding motif in the C-terminal regulatory domain of AMPK that is responsible for promoting Arf6 activation and, thus, inducing cell migration and invasion. These findings reveal a noncanonical role of AMPK in which its C-terminal regulatory domain serves as a GEF for Arf6 during glucose deprivation.

Self-cleaved expression of recombinant lysostaphin from its cellulose binding domain fusion

Mature lysostaphin (mLst) is a glycineglycine endopeptidase, capable of specifically cleaving penta-glycine crosslinker in the peptidoglycan of Staphylococcus aureus cell wall. It is a very effective therapeutic enzyme to kill the multidrug-resistant S. aureus often encountered in hospital acquired infections. Fusing cellulose binding domain (CBD) to mLst significantly reduced the insoluble expression of mLst in E. coli. Employing mLst-cleavable peptides as fusion linkers leaded to an effective self-cleavage expression that CBD and mLst could be completely cleaved off from the fusions during the expression process. The presence of residue linker fragment at N-terminus of the cleaved-off mLst strongly inhibited the cell lytic activity of the recovered recombinant mLst, and only ~ 50% of the wild-type mLst activity could be retained. Intact CBD-Lst fusions were obtained when uncleavable peptide linkers were employed. With CBD at N-terminus of mLst, the intact fusion completely lost its cell lytic activity but the dipeptidase activity still remained. In contrast, approximately 10% cell lytic activity of mLst still could be maintained for the fusion with CBD at C-terminus of mLst. KEY POINTS: • CBD fusion enhanced soluble expression of recombinant lysostaphin. • In vivo self-cleavage of fusion linkers by the expressed lysostaphin fusions. • Self-cleaved lysostaphin fusions retain most of dipeptidase but lose 50% cell lytic activity.

[Analysis of 1 case of convulsion death caused by large dose of diquat poisoning]

A retrospective analysis of a case of death from sudden convulsions caused by oral high-dose diquat was conducted, and the mechanism and treatment of central damage caused by diquat were investigated to lay the foundation for increasing the success rate of treatment of high-dose diquat poisoning. At the same time, at the same time, our clinical treatment experience has also been accumulated.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex.Level of evidence: IV.

Response of heart rate variability and cardiorespiratory phase synchronization to routine bronchodilator test in patients with asthma

Heart rate variability (HRV) and cardiorespiratory phase synchronization (CRPS) were employed to study the cardio- and respiratory interactions in patients with asthma receiving inhalation of beta2-agonist (Berotec 200 mcg) for routine bronchodilator test. Both time- and frequency-domain parameters were used to analyze the HRV. A weighted G-index was introduced to study the quality of the CRPS. The HRV parameters, in both the time and frequency domains, exhibited significant changes pointing to a sympathetic activation of the autonomic balance immediately after the inhalation. On the other hand, the CRPS index barely changed throughout the entire process. This indicates that inhalation of beta2-agonist does not alter the CRPS appreciably, and that the CRPS, in contrast to HRV, is relatively stable in response to the inhalation of beta2-agonist in patients with asthma.

An investigation of dynamic ulnar impingement after the Darrach procedure with ultrasonography

Dynamic ulnar impingement is a common and painful symptom after the Darrach procedure. However, the current detection method with static radiographs often falls short of examining the dynamically symptomatic wrists. We, therefore, investigate the utility of ultrasonography to assess dynamic ulnar impingement. In this cross-sectional study, 20 patients, with 22 wrists, who had undergone the Darrach procedure were evaluated at a mean of 55 months (range, 25-171) from the index procedure. Real-time ultrasonographic imaging in the axial plane of the bone and soft tissue was performed during three different dynamic testing methods, including weight-stressed (WS), pronation-supination (PS), and forceful fist clenching (FC), to investigate ulnar impingement. Dynamic radiographs were obtained for comparison. Clinical outcomes were evaluated with grip strength and patient-reported outcomes including pain in daily activities on a numeric rating scale (NRS), the Patient-Rated Wrist Evaluation (PRWE), and the Quick Disability of the Arm, Shoulder and Hand (QDASH). Ultrasonographic ulnar impingement found during PS method was associated with worse pain and function, yet impingement diagnosed with dynamic radiographs or ultrasonography with WS and FC method was not associated with worse outcomes. While radiographic impingement was found in a total of 12 wrists (55%), ultrasonography with the WS and PS method revealed true bone contact in only 2 (9%) and 4 (18%) of the wrists, respectively. The addition of ultrasonography may be valuable in follow-up evaluations after the Darrach procedure.

Effectiveness of Theory-Based Health Information Technology Interventions on Coronary Artery Disease Self-Management Behavior: A Clinical Randomized Waitlist-Controlled Trial

Purpose

Secondary prevention of coronary artery disease, self‐management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self‐efficacy theory–based health information technology intervention implemented through blood control and patient self‐management.

Design

A clinical randomized waitlist‐controlled trial.

Methods

The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self‐management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations.

Results

Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self‐management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective.

Conclusion

The use of a theory‐based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self‐management behavior, and QOL in patients with coronary artery disease.

Clinical Relevance

This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self‐management. It also may help guide further digital health care strategies during the COVID‐19 pandemic.

Impaired glucose homeostasis and a novel HLCS pathogenic variant in holocarboxylase synthetase deficiency: a report of two cases and brief review

Objectives Holocarboxylase synthetase deficiency (HCSD) (OMIM #253270) is a rare inborn error of metabolism with an estimated annual incidence of 1 in 200,000 people. Typical manifestations of HCSD include eczema, alopecia, lactic acidosis and hyperammonemia. Diagnosis is made through genetic analysis. Case presentation Patient 1 was a 7-year-old girl with normal growth and development, presenting with severe hypoglycemia and metabolic acidosis. Her family reported that she was diagnosed as having ketotic hypoglycemia; she had five episodes of hypoglycemia and metabolic acidosis in past 4 years when her oral intake decreased during acute illness. Patient 2 was a 6-month-old female infant with normal growth and development, presenting with progressive generalized eczema and metabolic acidosis for the first time. We found that they both had hyperammonemia, hyperlactatemia, hyperketonemia, organic acids detected in urine and elevated C5OH acylcarnitine level by tandem mass spectrometry. HLCS gene analysis showed a homozygous pathogenic variant p.V363D in patient 1 and a pathogenic variant p.R508W compound with a novel splice site pathogenic variant c.2010-1G>A in patient 2. They have been on biotin treatment (10 mg/day for both of them) for more than 2 years and no more symptoms have occurred. Conclusions HCSD is a rare disease, and it can be fatal if severe metabolic acidosis occurs without timely management. Once the diagnosis is made, most of the patients with HCSD have good prognosis and normal life expectancy with biotin treatment.

Randomized Clinical Trial on Sodium Fluoride with Tricalcium Phosphate

This 24-mo randomized controlled trial was based on a double-blind parallel design, and it compared the effectiveness of 2 fluoride application protocols in arresting dentine caries in primary teeth. Three-year-old children with active dentine caries were recruited and randomly allocated to 2 treatment groups. Children in group A received a semiannual application of a 25% silver nitrate (AgNO₃) solution followed by a commercially available varnish with 5% sodium fluoride (NaF) on the carious tooth surfaces. Children in group B received a semiannual application of a 25% AgNO₃ solution followed by another commercially available varnish with 5% NaF containing functionalized tricalcium phosphate (fTCP). Carious tooth surfaces that were hard when probing were classified as arrested. Intention-to-treat analysis and a hierarchical generalized linear model were undertaken. A total of 408 children with 1,831 tooth surfaces with active dentine caries were recruited at baseline, and 356 children (87%) with 1,607 tooth surfaces (88%) were assessed after 24 mo. At the 24-mo evaluation, the mean (SD) number of arrested carious tooth surfaces per child were 1.8 (2.2) and 2.6 (3.3) for group A (without fTCP) and group B (with fTCP), respectively (P = 0.003). The arrest rates at the tooth surface level were 42% for group A and 57% for group B (P < 0.001). Results of the hierarchical generalized linear model indicated that protocol B (with fTCP) had a higher predicted probability (PP = 0.656) in arresting dentine caries than protocol A (without fTCP; PP = 0.500) when the carious lesions were on buccal/lingual surfaces, were on anterior teeth, had dental plaque coverage, and were in children from low-income families (P = 0.046). In conclusion, protocol B, which applied a 25% AgNO₃ solution followed by a commercially available 5% NaF varnish with fTCP semiannually, is more effective in arresting dentine caries in primary teeth as compared with protocol A, which applied a 25% AgNO₃ solution followed by another commercially available 5% NaF varnish without fTCP semiannually (ClinicalTrials.gov NCT03423797).

Fixation of fifth metacarpal neck fractures: a comparison of medial locking plates with intramedullary K-wires

Surgical treatment for metacarpal neck fractures may be indicated for malrotation, palmar angulation exceeding 30° or metacarpal shortening exceeding 3 mm, although these thresholds have not been firmly established. In a retrospective study, we compared the clinical and radiographic results of 54 patients with displaced fifth metacarpal neck fractures who were treated with either medial locking plates (14 patients) or retrograde intramedullary K-wires (40 patients). At a mean follow-up of 26 months (range 12 to 62), metacarpal shortening and angulation were 2 mm greater and 4° greater, respectively, in the K-wire group. The plate group had an earlier return to work and greater aesthetic satisfaction, but operative time and complication incidence were higher. Range of motion, time to union, grip strength and Quick Disability of the Arm, Shoulder and Hand scores were similar. We conclude that medial plating offers no clear advantage over K-wire fixation in treating metacarpal neck fractures. Level of evidence: III.

Using tabletop exercises to evaluate nurses' clinical performance of hazardous materials disaster management: A cross-sectional study

BACKGROUND

Hazardous materials (Hazmat) disaster is a specific event with low probability but may be a heavy burden on public health. Competence in Hazmat disaster emergency management is necessary for nurses who care about mass casualties in the first line, especially for nurses in military hospitals. However, less attention has been paid to evaluation of competence of Hazmat disaster emergency responses using tabletop exercises.

OBJECTIVE

To identify competence in Hazmat disaster emergency response and factors influencing performance on tabletop exercises.

METHODS

A cross-sectional design was employed in this study. Competence of nurses responding to a hazardous materials invasion was evaluated by a tabletop exercise. In each case the "Task Based Checklist" was used for evaluation. Multivariate analysis of covariance was conducted to detect the effects of traditional training on performance in Hazmat disaster tabletop exercises.

RESULTS

A total of 161 nurses were recruited for this study. A checklist with 12 items comprised of two dimensions of disaster management was created and validated (CVI = 0.90). Inter-rater reliability for the evaluators ranged from 0.88 to 1. Performance on Hazmat site control, debris management and individual skills in decontamination were found to be suboptimal. Traditional disaster nursing training had no significant influence either on performance on Hazmat site control or patient care after controlling for differences in education level, age and gender.

CONCLUSIONS

The tabletop exercise is an innovative method for disaster nursing educators seeking to evaluate response competence in Hazmat disaster simulation exercises. It is necessary to consider the characteristics of the participants when designing the training program and educational strategies. Participants from the military hospital were shown to have limited competence in Hazmat disaster emergency management.

Cooperative recruitment of Arl4A and Pak1 to the plasma membrane contributes to sustained Pak1 activation for cell migration

Cell migration requires the coordination of multiple signaling pathways involved in membrane dynamics and cytoskeletal rearrangement. The Arf-like small GTPase Arl4A has been shown to modulate actin cytoskeleton remodeling. However, evidence of the function of Arl4A in cell migration is insufficient. Here, we report that Arl4A acts with the serine/threonine protein kinase Pak1 to modulate cell migration through their cooperative recruitment to the plasma membrane. We first observed that Arl4A and its isoform Arl4D interact with Pak1 and Pak2 and showed that Arl4A recruits Pak1 and Pak2 to the plasma membrane. The fibronectin-induced Pak1 localization at the plasma membrane is reduced in Arl4A-depleted cells. Unexpectedly, we found that Pak1, but not Arl4A-binding-defective Pak1, can recruit a cytoplasmic myristoylation-deficient Arl4A-G2A mutant to the plasma membrane. Furthermore, we found that the Arl4A-Pak1 interaction, which is independent of Rac1 binding to Pak1, is required for Arl4A-induced cell migration. Thus, we infer that there is feedback regulation between Arl4A and Pak1, in which they mutually recruit each other to the plasma membrane for Pak1 activation, thereby modulating cell migration through direct interaction.

[Effect of different medication time prior to corneal refractive surgery on tear film stability]

Objective: To investigate the effect of different medication time prior to corneal refractive surgery on tear film stability. Methods: Prospective cohort study. A total of 60 patients (60 eyes), including 38 males (63.3%) and 22 females (37.7%) with an average age of (24.2±5.1) years (form 18 to 37 years), who had planned for corneal refractive surgery with normal ocular surface disease index score were included in this study. The patients were divided into 1d group (medication of 1 day, 30 eyes) and 3d group (medication of 3 days, 30 eyes) randomly. The first tear break up time (FBUT), the average tear break up time (AVBUT) and the dry eye grade score were recorded on the examination day and the operation day with Keratograph 5M. The difference of FBUT and AVBUI between the two groups was compared with the independent sample t test. The difference of FBUT and AVBUT between the examination day and the operation day was compared with the paired t test. The difference of the dry eye classification between the two groups was compared using chi-square test. Results: The FBUT and AVBUT of 1d group and 3d group were (10.89±5.19)s and (10.88±6.82)s, (16.24±3.62)s and (16.21±4.74)s respectively in preoperative examination, and (10.65±6.03)s and (8.14±5.75)s, (15.14±5.30)s and (12.86±5.92)s respectively in operation day. There was no significant difference in FBUT and AVBUT between the two groups (t=0.01, 1,47, 0.02, 1.44; P>0.05). However, in the 3d group, the AVBUT of operation day decreased as compared with that of the examination day, and the difference was statistically significant (t=2.31, P<0.05). There was no significant difference in the distribution of dry eye classification between the two groups (χ(2)=0.07, 3.36; P>0.05). Conclusion: Both of medication of 1 day and medication of 3 days prior to corneal refractive surgery can provide a similar tear film stability, however more attention should be paid to the medication for patients with asymptomatic but abnormal BUT. (Chin J Ophthalmol, 2018, 54: 744-747).

Effect of pre-slaughter shackling and wing flapping on plasma parameters, postmortem metabolism, AMPK, and meat quality of broilers

The objective of this study was to determine the effects of shackling and wing flapping on stress, postmortem metabolism, AMP-activated protein kinase (AMPK), and quality of broiler pectoralis major. Before slaughter, a total of 80 Arbor Acres broilers was randomly categorized into 2 replicate pens (40 broilers per pen) and each pen randomly divided into 2 groups (shackling, T; control, C). Corticosterone, creatine kinase, and lactate dehydrogenase were determined on blood plasma parameters. Pectoralis major were removed after evisceration and used for determination of energy metabolism, meat quality, and AMPK phosphorylation. In this study, shackling and wing flapping increased (P < 0.05) plasma corticosterone level, creatine kinase activity, and lactate dehydrogenase activity. Shackling and wing flapping increased (P < 0.05) AMPKα(Thr172) and acetyl-CoA carboxylase (ACC) phosphorylation, followed by rapid glycolysis and accumulation of lactic acid, and leading to a fast pH decline in the initial postmortem meat. Shackling and wing flapping have an adverse effect on final meat quality, which increased (P < 0.05) muscle lightness, drip loss, and cooking loss. The results indicate that antemortem shackling and wing flapping increased stress and AMPKα(Thr172) phosphorylation, which may accelerate glycolysis and lead to a low water-holding capacity of broiler meat.

Tunable quantum dot arrays as efficient sensitizers for enhanced near-infrared electroluminescence of erbium ions

Under electrical pumping conditions, high-efficiency Si-based near-infrared light generation and amplification on a chip have long been pursued for future optical interconnection technology. However, the overall performance of Si-based near-infrared electroluminescence (EL) devices, including the overall efficiency, turn-on voltage and stability under operational conditions, can rarely meet the requirements of monolithic optoelectronic integration. In this work, we designed a confined crystallization growth strategy for fabricating metal oxide quantum dot (QD) arrays embedded in Si-based films as sensitizers of Er³⁺ ions. Through the precise control of particle size and number density of QD sensitizers, the near-infrared photoluminescence (PL) emission of Er³⁺ ions can be enhanced by more than three orders of magnitude. More significantly, such hierarchical control over the regular arrangement of QD arrays not only considerably enhances the resonance energy transfer efficiency, but also offers an effective conduction path for carrier transport. Therefore, the corresponding near-infrared EL device exhibits a decreased turn-on voltage of 4.5 V, a high external quantum efficiency of 0.7%, and a long operational lifetime of more than 1000 hours, making this device superior to most Si-based on-chip near-infrared EL devices. This well-controlled metal oxide QD array represents an ideal sensitizer to effectively promote the EL emission of rare earth ions and reduce the turn-on voltage. Meanwhile, the analysis of the carrier transport mechanism paves the way for future research into resonance energy transfer under electrical pumping conditions.

The effects of electrical stunning voltage on meat quality, plasma parameters, and protein solubility of broiler breast meat

This study was designed to compare the effects of different stunning voltages of pulsed direct current on meat quality of broilers. For this purpose, plasma parameters, blood loss, carcass damage, and meat water holding capacity, color, shear force, pH, and protein solubility were analyzed. A total of 400 broilers were divided into 5 treatment groups and stunned with 5, 15, 25, 35, and 45 V at 750 Hz and 10 s, respectively. Blood samples were collected immediately after cutting the neck. Pectoralis major muscles were removed from the carcass after chilling and placed on ice. Breast muscle pH and meat color were determined at both 2 and 24 h postmortem. Dripping loss, cooking loss, pressing loss, and cooked breast meat shear values were determined after 24 h postmortem. The 5 V treatment significantly increased (P < 0.05) blood plasma corticosterone and lactate concentration compared with the other groups. The carcass damage of wings, Pectoralis major, and Pectoralis minor was significant in the 5, 35, and 45 V groups. The pH of 2 h postmortem in the 5 and 45 V groups was significantly lower (P < 0.05) than in the 15 and 25 V groups. In the 5 and 45 V groups, the protein solubility and shear force value were significantly lower (P < 0.05) and dripping loss was significantly higher (P < 0.05) than the other groups.

Effect of fast pH decline during the early postmortem period on calpain activity and cytoskeletal protein degradation of broiler M. pectoralis major

The objective of this study was to determine the effects of fast pH decline during the early postmortem period on calpain activity and the degradation of cytoskeletal proteins in broilers. Eighty broilers were randomly categorized into two groups: physical restraint (PR) and free struggle (FS). M. pectoralis major (PM) was used for determination of calpain activity, shear value, ultrastructure of myofibrils, and the degradation of desmin, titin, nebulin, and troponin-T. The pH (6.05) of FS group is significantly low than PR group (6.38) at 0.3 h postmortem. Fast pH decline during the early postmortem period led to a decrease of μ/m-calpain activities at 0.3 and 3 h postmortem (P < 0.05), but did not affect the ultimate μ/m-calpain activity. An initial fast decrease in pH increased the degradation of desmin, titin, nebulin, and increased the 30 kDa degradation fragments of troponin-T. Therefore, the fast pH decline during the early postmortem period decreased the μ/m-calpain activity and increased the degradation of cytoskeletal proteins in broiler muscle. It is possible that the fast pH decline experienced an earlier activation of calpains that resulted in earlier protein degradation and ultimately lower shear force.

Characterization of grass carp spleen transcriptome during GCRV infection

The aim of the study was to investigate the grass carp hemorrhagic infection pathway and its key-related genes. Grass carp reovirus (GCRV) might cause hemorrhagic disease in grass carps. Healthy grass carp fingerlings (N = 60) were divided into control and infected groups. Fish in the control group were intraperitoneally (ip) injected with 0.6% fish physiological saline; the infected group received 5,000,000 50% tissue culture infective doses of GCRV 873 standard strain, a double-stranded RNA (dsRNA) virus strain, ip, in 0.5 mL. Illumina HiSeqTM 2000 was used for transcriptome sequencing, and real-time polymerase chain reaction (PCR) used to detect complement factors II (C2), III (C3), and V (C5); profibrinolysin (PLG); and coagulation factor II (F2) expression. A total of 2,722,223 reads were detected in the control group, and 2,751,111 in the infected group. Among 11,023 unigenes obtained after transcriptome assembly, 10,021 unigenes were significantly differentially expressed. Gene ontology and KEGG analysis, a collection of databases dealing with genomes and biological pathways, were performed to classify unigenes into functional categories, to understand gene function and identify regulatory pathways. Real-time PCR analysis showed that C2, C3, C5, PLG, and F2 expression levels were down-regulated, confirming results of pathway-enrichment analysis. This is the first application of high-throughput sequencing technology to investigate the in vivo effects of GCRV, on genes and pathways involved in the immune response to infection in grass carp.

The effects of total contact insole with forefoot medial posting on rearfoot movement and foot pressure distributions in patients with flexible flatfoot

The purpose of this study is to evaluate the therapeutic effect of total contact insole with forefoot medial posting (TCIFMP) orthosis in patients with flexible flatfoot. The TCIFMP insole was custom- mode, made from semi-rigid plastazote and PPT. Using the gait analysis and the plantar-pressure measure systems, we investigate rearfoot motion and plantar pressure redistribution in these patients. The results of this study showed that the excessive valgus movement of the rearfoot can be reduced significantly by the TCIFMP insole in these patients. Besides, there were significant decreases in the peak pressure under the toe, lateral metatarsal, lateral foot and heel areas. Therefore, we suggested that the TCIFMP insole is an effective orthotic device for rearfoot motion control, plantar pressure reduction and re-distribution in patients with flexible flatfoot.

Cloning, characterization and expression analysis of coagulation factor II gene in grass carp (Ctenopharyngodon idella)

Here, we characterized the structure and function of the coagulation factor II (FII) gene in grass carp and determined its role in coagulation mechanisms. The FII gene EST was obtained using a constructed splenic transcriptome database; the full-length FII gene sequence was obtained by 3' and 5' RACE. The open reading frame (ORF) of FII was cloned and the full-length gene was found to be 1718 bp, with an ORF of 1572 bp; the gene contained a 25 bp 5'-untranslated region (UTR) and 108 bp 3'-UTR. The ORF encoded 524 amino acids, including 74 alkaline amino acids (arginine and lysine) and 69 acidic amino acids (aspartic acid and glutamic acid). The theoretical pI was 6.22. The calculated instability index (II) was 39.81, indicating that FII was a stable protein; the half-life period was predicted to be approximately 30 h. Amino acid sequence comparisons indicated that grass carp FII showed most similarity (71%) to FII of Takifugu rubripes, followed by Oplegnathus fasciatus (48% similarity) and Larimichthys crocea (47% similarity). A real-time reverse transcription PCR analysis showed that under normal circumstances, FII was most highly expressed in the liver, followed by the gill, spleen, thymus, and head-kidney (P < 0.001). After injection of the grass carp reovirus 873 (GCRV873), the pattern of FII expression was significantly altered (P < 0.001); gene expression was high after injection, suggesting a response involving the initiation of the coagulation system and defense of the body in combination with the platelet and complement system.

Trimetallic (aurod-pdshell-ptcluster) catalyst used as amperometric hydrogen peroxide sensor

Bimetallic nanostructured core-shell structures are commonly used as catalysts in a wide variety of reactions. We surmised that the addition of an additional metal would potentially allow catalytic tailoring with the possibility of an increase in activity. Here a tri-metallic catalytic structure, consisting of clustered catalytic Pt on the surface of a Pd shell supported on a rod shaped Au core was fabricated. The significance of the additional metallic component is shown by comparative electrochemically active surface area (ECSA) analysis results for the trimetallic Au_rod-Pd_shell-Pt_cluster, bimetallic Au_rod-Pt_cluster and monometallic JM-Pt (used as a reference), which have respective ECSA values (cm²/mgPt) of 1883.0, 1371.7 and 879. The potential utility of the trimetallic catalysts was shown in a hydrogen peroxide sensing protocol, which showed the catalyst to have a sensitivity of 604 ìA/mMcm² within a linear range of 0.0013–6.191 mM.

SIM2 maintains innate host defense of the small intestine

The single-minded 2 (SIM2) protein is a basic helix-loop-helix transcription factor regulating central nervous system (CNS) development in Drosophila. In humans, SIM2 is located within the Down syndrome critical region on chromosome 21 and may be involved in the development of mental retardation phenotype in Down syndrome. In this study, knockout of SIM2 expression in mice resulted in a gas distention phenotype in the gastrointestinal tract. We found that SIM2 is required for the expression of all cryptdins and numerous other antimicrobial peptides (AMPs) expressed in the small intestine. The mechanism underlying how SIM2 controls AMP expression involves both direct and indirect regulations. For the cryptdin genes, SIM2 regulates their expression by modulating transcription factor 7-like 2, a crucial regulator in the Wnt/β-catenin signaling pathway, while for other AMP genes, such as RegIIIγ, SIM2 directly activates their promoter activity. Our results establish that SIM2 is a crucial regulator in controlling expression of intestinal AMPs to maintain intestinal innate immunity against microbes.

High-volume plasma exchange in a patient with acute liver failure due to non-exertional heat stroke in a sauna

Heat stroke is a life-threatening condition characterized by an increased core body temperature (over 40°C) and a systemic inflammatory response, which may lead to a syndrome of multiple organ dysfunction. Heat stroke may be due to either strenuous exercise or non-exercise-induced exposure to a high environmental temperature. Current management of heat stroke is mostly supportive, with an emphasis on cooling the core body temperature and preventing the development of multiple organ dysfunction. Prognosis of heat stroke depends on the severity of organ involvement. Here, we report a rare case of non-exercise-induced heat stroke in a 73-year-old male patient who was suffering from acute liver failure after prolonged exposure in a hot sauna room. We successfully managed this patient by administering high-volume plasma exchange, and the patient recovered completely after treatment.